The spotlight is on low and no-calorie sweeteners ahead of the anticipated release of draft guidelines on the intake of non-sugar sweeteners from the World Health Organization (WHO) Nutrition Guidance Expert Advisory Group (NUGAG). A new report publicized by the International Sweeteners Association (ISA) argues that there is an extensive body of robust scientific evidence that shows that low and no-calorie sweeteners are safe and can be part of broader strategies to reduce sugar intake. However, this is still an area of controversy, with experts telling how the microbiome is a particular potential point of concern.

“Low and no-calorie sweeteners are no silver bullet. However, and as supported by robust scientific evidence, low and no-calorie sweeteners provide a simple way to reduce the amount of calories and sugars in our diet, when used as part of a balanced diet and healthy lifestyle. They can also help meet current dietary guidelines recommending the reduction of excessive sugar consumption without affecting the enjoyment of sweet-tasting foods and drinks,” highlights an ISA spokesperson.

Published in Nutrition Research Reviews, the new paper gathers the consensus of 17 experts in a workshop following a conference held by ISA. They agreed that low and no-calorie sweeteners have a beneficial role to play in helping achieve sugar and calorie intake reduction, as well as noting that the safety of low and no-calorie sweeteners need to be communicated in a consistent manner.

Ultimately, the experts concluded that efforts should be made to understand and, where possible, reconcile policy discrepancies between organizations. Moreover, it is necessary to reduce regulatory hurdles that impede product development and reformulation designed to reduce sugars or calories.

“On this basis, we hope that the recommendations from this scientific report will assist policymakers and other stakeholders, including NGOs, health professionals, research funding bodies and the food and beverage industry,” says the ISA spokesperson.

Low and no-calorie sweeteners have a beneficial role to play in helping achieve sugar and calorie intake reduction, says the ISA.

Part of a short-term transition
Weighing in on the report, Linia Patel, spokesperson for the Association of UK Dietitians (BDA) and Registered Dietitian, expects that these findings will influence the WHO NUGAG guidelines. “Low and no-calorie sweeteners can indeed make a useful contribution to public health strategies aiming at sugar reduction. In addition to playing a helpful role in reducing total energy intake and thus in weight maintenance, they can also be a significant aid to people with diabetes who need to manage their carbohydrate intake.”

However, she also flags that the use of low and no-calorie sweeteners should only be part of a short-term transition. She argues that the use of artificial sweeteners should be considered along with other measures like general healthy eating, portion control and lifestyle advice.

The WHO guidelines are expected to be released toward the end of next year or in early 2021. “These recommendations are important because they are based on the latest scientific evidence. We take a systematic look at whatever has been published, before grading the quality of the evidence. This is to ensure that we are using the best scientific understanding,” Francesco Branca, Director of the Department of Nutrition for Health and Development (NHD) at the WHO, told.

Health concerns?
Low and no-calorie sweeteners have been the subject of great controversy in recent years as a glut of studies has come to contradictory results about their safety. At the start of last year, a major review found that there is no compelling evidence that non-sugar sweeteners improve health or help people lose weight. Last July, a paper pointed out “serious flaws” in the reassurance provided in 2013 by the European Food Safety Authority (EFSA) about the safety of aspartame.

There have been preliminary studies looking at the effect of these sweeteners on gut health.

More recently, an American Academy of Pediatrics (AAP) policy statement called for the amount of low and no-calorie sweeteners to be listed on product labels. It argued that more research was needed to gain a better understanding of how low and no-calorie sweeteners impact children’s long-term health.

Patel reiterates that low and no-calorie sweeteners have their place and if used in moderation are safe. Over the past decades, various reports have claimed that low-calorie sweeteners are associated with a range of adverse health effects, but the evidence for these claims are without substance, she states.

Nonetheless, she also highlights that there have been preliminary studies looking at the effect of these sweeteners on gut health, which found they have a negative effect on gut microbiota. However, she further notes that as these findings are limited by only using animals, meaning more research on humans is needed to fully understand this and its implications.”

Notably, a review of numerous studies, clinical trials and chronic clinical studies last month found that people who use low-calorie sweeteners are more likely to gain weight and may be at higher risk of developing Type 2 diabetes. Review author Peter Clifton argues that the ISA should not ignore these publications examining the microbiome.

“This area has never been examined by the authorities, and every sweetener will have a different effect. I expect that the WHO will conclude more data is required before a conclusion can be made about their overall effect on public health,” Clifton predicts.